Blog #10: Indoor Air Pollution

Carbon monoxide is released into indoor spaces via heating and cooling units, gas stoves, wood stoves, and other sources. Even at low levels, carbon monoxide can cause mild health effects including headache, nausea, fatigue, and confusion. In larger doses, it can be fatal. Micro-organisms, such as fungal spores and mold, may grow in areas inside the home that exhibit inadequate ventilation and excess moisture, such as the bathroom, basement, or crawl space. Mold can lead to mild conditions like sinus irritation and respiratory infections, and at higher levels, infertility. It has also been known to worsen asthma symptoms along with other allergens like dust, smoke, and dander. Dust mites can live in areas all over the home including pillows, blankets, carpet, mattresses, and upholstered furniture. In addition to exacerbating asthma, dust, smoke, and dander can cause nose and throat irritation, nasal congestion, sneezing, and coughing. Infectious disease is another danger of indoor air. Working in offices, hospitals, or other areas that use recirculated air ventilation can contribute to the spread of illnesses like colds, influenza, and other dangerous viruses. Within all buildings, including homes, offices, hospitals, stores, etc., toxic compounds are present in building materials, furniture, carpets, paint, cleaning chemicals, and many other places. Some older buildings may still contain dangerous chemicals like lead and asbestos that can lead to serious health effects like cancer. Radon is found in the soil and ground water and has been known to be detectable in homes and other buildings. Radon is the second leading cause of lung cancer after cigarettes.

In my home I have a gas stove and oven that is used almost daily. There is a large exhaust fan over the stovetop that is used when it gets smoky in the house from cooking, but is not used routinely. I would worry about small amount of carbon dioxide while cooking. We do have carbon monoxide detectors that are functioning, but as mentioned above, even small amounts of carbon monoxide can have some negative effects. I also have an exhaust fan in the bathroom that is turned on whenever the shower is in use to remove moisture. There is a dehumidifier in the basement/garage to keep down moisture and mold growth. I have a Molekule air filter that I bought about 2 months ago that runs continuously. It is designed to cover quite a large area, up to 600 square feet. Molekule uses Photoelectrochemical Oxidation to destroy indoor air pollutants. It is designed to rid the indoor environment of substances as small as viruses, and I believe that it greatly improves the air quality inside my house. I am curious to what types of technologies they use in hospitals to keep viruses and other air pollutants from spreading from patient to patient. With the cleaning chemicals used in hospitals on a continuous basis, I would be concerned about the air quality in hospitals. The previous article I read about asthma in nurses makes me believe that the air quality in hospitals is quite poor.

Alameda county has an Environmental Performance Specifications Checklist for New Construction and Major Remodels (link below) that outlines specific requirements for things like carpets, paints, adhesives, wood finishes, and other important areas of potential contamination during and after construction. The specifications follow current policies and are designed to reduce environmental impact and provide an optimal indoor environment with the finished product. A study performed by UC, Berkeley in 2012 found that there were higher than allowable levels of formaldehyde in day care centers in Northern California. I could not find any information regarding any steps to remedy this over the past seven years, so I would guess that this is an ongoing issue.

Environmental Performance Specifications: https://www.acgov.org/sustain/documents/SustainableDesign_Checklist.pdf

Berkeley Study on Formaldehyde: https://news.berkeley.edu/2012/10/25/formaldehyde-in-daycare-centers/

In practice, I currently do not educate patients about indoor cooking risks and proper air flow, but I believe that this information would be beneficial to share with many patients in the future. Even gas stoves and ovens release some amount of carbon monoxide, and ventilation is still important. Many homes in the U.S. have gas appliances, and consumers are likely unaware of their risk of exposure. Although not typically used for cooking in the U.S., wood stoves and fireplaces still exist in many homes. Patients must be educated about proper ventilation via chimneys or exhaust fans to reduce their exposure to harmful particulate matter within the home.

Blog #9: Health Effects of Air Pollution

It seems intuitive that air pollution would worsen asthma symptoms, but I was astounded to learn some of the deeper reasons behind the matter. Per the article from Berkeley news regarding air pollution and immune function, air pollution is much more than just a source of inflammation. Air pollution actually suppresses the activity of regulatory T cells, which leads to more severe asthma symptoms by taking the “brakes” off of the immune system. The failure of the regulatory T cells to regulate the immune response increases asthma symptoms. Children in highly polluted areas have higher rates of asthma, and it is no wonder. We can all do something to reduce our impact on the environment. When I graduate and have the money, I plan to buy an electric car. Until then, I’ve been trying to use public transportation more often to reduce the amount of pollutants I put into the air.

Looking into the environmental risks in my area using the myRTK tool, I found a metal foundry close to my home (AB&I Foundry) that releases lead compounds into the air and water. It does not appear to be a significant amount, and they have been mostly in compliance for the past three years, but as I have learned during this class, no amount of exposure to lead is safe. There is also a chemical compounding company close to my neighborhood about which I found some information. They surprisingly did not release a significant amount of pollutants into the air, and none into the water or land. There are several pharmacies and dry cleaners scattered throughout the area as well, but without statistics since they do not report to TRI.

In California, both the EPA and the California Air Resources Board (CARB) set air quality standards. The CARB’s main mission is to protect the health of the people of California from the harmful effects of pollution. This actually brings to mind the stories in the news lately about California attempting to pass stricter regulations on emissions and being challenged by Trump. An article from NPR from September 24 (below) mentions the letter sent by the EPA administrator, Andrew Wheeler, to CARB threatening to withdraw highway funding for California unless the state is able to quickly remedy a lack of air pollution control plans. California does not meet air quality standards under the Clean Air Act because of many contributing factors. California recently submitted a waiver to allow stricter car emissions standards, which was revoked by the Trump administration. How can California improve its air quality and meet standards when their plans to do so are rejected?

Here is the NPR article.

https://www.npr.org/2019/09/24/763876070/trump-administration-escalates-battle-over-environmental-regulations-with-califo

The articles in this module absolutely relate to my current practice as well as my clinical rotation this semester. I currently work with the elderly population in an outpatient clinic, and being in Alameda county, my patients are exposed to relatively high levels of air pollution every day. According to the American Lung Association, Alameda county currently receives an F in ozone and particulate pollution. Particulate matter can contribute to a variety of health effects including cardiovascular and cerebrovascular disease, activation of the clotting system, respiratory effects, and deactivation of regulatory T cells. This semester I will be doing a pediatric rotation, and my preceptor informed me that she sees a lot of children with asthma at her practice. I do not find this surprising at all after learning what I did from the Berkeley news article I mentioned above. The increased levels of air pollution that we experience in the 21^st century contribute to worsening asthma symptoms. To educate patients and parents, I would point out that increased exposure can worsen symptoms. Exercising or playing outside in areas that have high levels of particulate matter in the air can significantly worsen asthma symptoms. For those with more severe symptoms, I would perhaps recommend checking the air quality each day and maybe wear an N95 mask on the days that air quality is particularly bad.

Blog #8: Environmental Justice

There is certainly environmental racism throughout the state of California in regards to the minority populations that work in the central valley in the agriculture industry. The exposure to toxic chemicals from pesticides and other agricultural toxins is significantly higher in those that live and work in these areas than in the general population. Studies have shown that the effects from exposure have detrimental effects on cognitive and physical development. I have heard the term environmental justice before, but did not know that it encompasses so many aspects of environmental health and social determinants of health. Just driving around the community, it is clear that we still have a ways to go for environmental justice. Lower income neighborhoods tend to be closer to freeways and train tracks, which produce not only air pollution, but noise pollution as well. Living close to the hills in Oakland, it is clear that those with higher income live in the hills, farther from freeways, heavy traffic, and noise. Social determinants of health certainly include environmental justice as a major aspect. There are many factors to environmental justice that overlap with social determinants. The WHO defines social determinants of health as the conditions in which individuals are born, grow, live, and work. Living in poverty can force individuals and families to live in certain environments that are detrimental to their health. We need to, as voters and as health care providers, must fight to ensure that our battle toward environmental justice continues. Laws that prevent activities such as dumping of toxic materials and building of landfills do not continue to occur in areas in which minorities and low income populations live. With the social determinants that they already face, such as lack of sidewalks and lack of access to healthy food, we must do what we can to protect these communities.

Since climate activist, Greta Thunberg, came to New York this week, I’ve been following her and her supporters. I was just looking through the articles from this past week about the massive demonstrations taking place around the world to demand change in favor of protecting our planet. The article below talks about the tens of thousands of people that came out just in New York City to show their support. Students were even excused from school to attend. I was so heartened to see that young people, Greta being only 16 years old, understand the damage that humans are doing to our fragile planet. These demonstrations give me hope about our future although it often looks so dim. With the massive support that Greta has invoked, I hope that our lawmakers will finally start to listen. It makes me realize how important our next big election is going to be. I hope that this gets people hyped up to vote!

https://www.nytimes.com/2019/09/20/nyregion/climate-strike-nyc.html